Volume 101 ·  Issue 22 ·  2021

To meet the challenges in the diagnosis and treatment of systemic light chain (AL) amyloidosis, the China Systemic Light Chain Amyloidosis Collaborative Group, together with multidisciplinary experts, developed the "Guideline for the Diagnosis and Treatment of Systemic Light Chain Amyloidosis" in 2016. In order to introduce progress in this field and better guide the clinical practice, the guideline has been updated recently. The in-depth understanding of AL amyloidosis has not only improved the level of diagnosis and treatment of the disease, but also promoted the integration of multiple disciplines, accelerated the development of clinical trials and the improvement of disease diagnosis and treatment modes.

Since the outbreak of coronavirus disease 2019 (COVID-19), the diagnosis and treatment of diseases has been greatly affected. Obstructive sleep apnea hypopnea syndrome (OSAHS) is a common chronic disease, whose diagnosis and treatment methods have changed dramatically during the epidemic period-from traditional outpatient diagnosis and treatment to online remote diagnosis and treatment based on Internet. The diagnostical capability of major sleep centers has increased instead of decreasing. But with the change of diagnosis and treatment mode, privacy, data security, medical insurance policy and other related issues also emerge as the times require. Under the normalization of epidemic situation, telemedicine not only creates new opportunities, but also faces unprecedented challenges.

Sleep Medicine is a clinical specialty covering the main categories of sleep-wake disorders. The formal training system for sleep medicine has been established in many countries, but not yet in China. The implementation of a pilot sleep medicine fellowship program was elaborated in this article, based on needs assessment of the relevant affiliated hospitals and teaching hospitals of Peking University Health Science Center. It was intended to draw on experiences to build up formal sleep medicine training system in future.

Sleep health becomes an important component of global public health. The incidence of sleep disorders is increasing rapidly worldwide, which seriously affects people′s quality of life. In China, the lack of professional sleep physicians and technicians, the distribution of sleep centers and the unbalanced development of medical resources have seriously restricted the development of sleep medicine and the improvement of sleep health guarantee level. In Europe and America and other developed countries, sleep medicine has become a new interdisciplinary discipline. The development of nurses as sleep coordinator has become an irresistible trend. Nurses have been trained to become the main force of sleep technicians. These successful attempts in the field of sleep medicine provide reference for promoting the development of nursing care in China from the aspects of medical care, teaching and research.

Systemic light chain (AL) type amyloidosis refers to a disease in which amyloid protein formed by monoclonal light chain as a precursor material is deposited into a variety of tissues and organs, resulting in tissue damage and organ dysfunction. In recent years, the field of AL-type amyloidosis has made rapid progress, with increasingly accurate diagnostic methods, endless new treatment drugs, and significant improvement in the long-term prognosis of patients. In order to further promote the high-quality standardized diagnosis and treatment of AL amyloidosis and better guide the clinical practice of Chinese doctors, the National Clinical Medical Research Center for Kidney Diseases of Eastern Theatre General Hospital and the National Clinical Medical Research Center for Hematological Diseases of Peking University People's Hospital jointly updated the Guidelines for Diagnosis and Treatment of Systemic Light Chain Amyloidosis formulated in 2016 with experts in related fields.

As a common chronic disease, obstructive sleep apnea hypopnea syndrome (OSAHS) is closely related to the occurrence and development of hypertension, arrhythmia, diabetes, stroke and other diseases. In recent years, the development of telemedicine has provided new ideas for the screening, diagnosis and treatment of this disease. Therefore, the Sleep Breathing Disorder Working Committee of Respiratory Physicians Branch of Chinese Medical Doctors Association and the Expert Committee of Sleep Health Project of "Huatuo Project" organized relevant domestic experts to discuss the remote diagnosis, remote treatment, follow-up, doctor-patient communication, participants and data security of OSAHS with reference to domestic and foreign clinical research literatures, and formulated this expert consensus to provide reference for building OSAHS telemedicine system based on China's national conditions.

To study the characteristics of cardiopulmonary function in patients with chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) overlapping syndrome (OS).

A total of 149 COPD patients, who were on stable treatment, were enrolled from the Second Affiliated Hospital of Soochow University from December 2017 to December 2019. The patients were divided into the OS group (n=56) and the COPD only group (n=93) according to their apnea hypopnea index (AHI) measured by the Apnealink device. Data were gathered from polysomnograph (PSG), spirometry, arterial blood gas and N-terminal pro-brain natriuretic peptide (NT-proBNP) assay to assess the cardiopulmonary function of patients. Partial correlation analysis was used to analyze the correlation between AHI and various factors, to study the characteristic changes in the cardiopulmonary function of these OS patients.

There were no significant cross-group differences in age and gender (all P>0.05). In the OS group, the forced expiratory volume in one second to forced vital capacity ratio (FEV₁/FVC), the forced expiratory volume in the first second expressed as percent predicted (FEV₁%pred), pH[M (Q₁, Q₃)], partial pressure of oxygen (PaO₂) and oxygen saturation (SaO₂) were lower than those in the COPD group [(49.46±12.98)% vs (54.38±11.72)%, (47.86±14.78)% vs (57.78±15.81)%, 7.37(7.34, 7.39) vs 7.40(7.39, 7.41), (80.75±10.20) vs (84.28±8.43) mmHg (1 mmHg=0.133 kPa), (94.46±2.52)% vs (95.74±2.28)%], whereas partial pressure of carbon dioxide (PaCO₂) [M (Q₁, Q₃)] was higher than that in the COPD group [55.00 (45.50, 60.00) vs 44.00(40.00, 48.00)mmHg] (allP<0.05). Pulmonary arterial pressure and plasma NT-proBNP levels [M (Q₁, Q₃)] in the OS group were significantly higher than those in the COPD group [38.90 (28.60, 49.05) vs 28.60 (24.95, 32.60) mmHg, 434.00 (273.75, 631.00) vs 136.00 (86.00, 205.00) pg/ml] (P<0.05). Partial correlation analysis showed that AHI was positively correlated with PaCO₂, pulmonary artery pressure, NT-proBNP, and acute exacerbation events (r values: 0.496, 0.544, 0.628, 0.446), and negatively correlated with FEV₁/FVC, FEV₁%pred, pH, PaO₂, and SaO₂ (r values:-0.309, -0.346, -0.410, -0.289, -0.267) (all P<0.05).

Patients with OS suffer from more severe hypoxemia, hypercapnia and pulmonary function damage, and their pulmonary arterial pressure and NT-proBNP are significantly higher than those with COPD only.

To explore the feasibility of applying telemedicine model in disease management for patients with obstructive sleep apnea hypopnea syndrome (OSAHS) in China.

A total of 24 patients were enrolled with suspected OSAHS who were admitted to the Sleep Center of Peking University People′s Hospital from October 2015 to September 2016. Patients were diagnosed by electronic questionnaire assessment and home sleep apnea monitoring (HSAT) and were treated with remote automatic positive airway pressure (APAP). After 1 week, 1 month and 3 months of treatment, the patients were followed up by video. The follow-up questionnaire was completed by the patients through an independent data management platform. The APAP treatment data and compliance data were obtained through a built-in digital card of the APAP device. Linear regression model was used to explore the factors related to patient compliance. One-way repeated-measure analysis of variance was used to compare the changes of APAP duration and apnea hypopnea index (AHI) among patients at different treatment time points. Paired t-test was used to compare the EPWORTH scale (ESS) scores before and after treatment.

A total of 22 patients were diagnosed with OSAHS, including 20 males (90.9%), aged (45.6±10.2) years and AHI before treatment was (46.9±20.4) times/h. A total of 20 OSAHS patients received APAP treatment, and the proportion of patients with good compliance after 1 week, 1 month and 3 months of treatment were 15/19, 10/19 and 8/18, respectively. The severity of sleepiness before treatment affected compliance. Each 1-point increase in ESS score was associated with a 6.16% (95%CI: 3.01%, 9.31%) increase in compliance. Age, body mass index and AHI before treatment had no effect on compliance (all P values>0.05). The AHI of the patients who had been treated for 1 week, 1 month and 3 months were (2.5±2.1), (2.2±1.6) and (1.9±1.0) times/h, respectively. (P=0.195). After 3 months of treatment, the ESS score was (7.0±3.3), lower than that before treatment (10.6±3.1) (P=0.079).

Telemedicine mode of diagnosis and treatment of OSAHS patients has good therapeutic effect and patient compliance, which is practical and feasible.

To evaluate the utility of a type 3 portable monitor (PM) at home for the diagnosis of sleep disordered breathing (SDB) in patients with stable congestive heart failure (CHF).

Seventy-six consecutive patients with CHF (61 males, 15 females, mean±standard deviation age (57.0±16.9) years) were enrolled from the sleep center of Peking university People′s Hospital during January 2016 to January 2019, and underwent overnight, unattended home sleep apnea testing (HSAT) with a portable monitor followed by an overnight simultaneous polysomnogram (PSG) with in-laboratory portable monitor (in-lab PM) recording within one week. The consistency of apnea hypopnea index (AHI), obstructive sleep apnea index (OAI), central sleep apnea index (CAI) between HSAT and PSG as well as the in-lab PM and PSG were analyzed by Bland-Altman plot; the sensitivity and specificity of PM for the diagnosis of SDB in patients with CHF were evaluated.

The number of patients included in the final analysis were 65 in HSAT, 63 in in-lab PM and 65 in PSG. AHI [M(Q₁,Q₃)] was 26.1 (10.9,40.1) events/h by HSAT, 27.9 (11.3,43.2) events/h by in-lab PM, both were not different from AHI 29.0 (10.2,45.0) events/h by PSG (P>0.05). The AHI, OAI and CAI assessed by HSAT correlated significantly with those by PSG (r=0.892, 0.903, 0.831, P<0.05). Bland-Altman analysis of AHI, OAI, CAI by PSG versus HSAT showed a mean difference of 3.1 events/h, 0.8 events/h, 1.2 events/h; limits of consistency were -15.2 to 21.4 events/h, -9.7 to 11.3 events/h, -10.9 to 13.2 events/h, respectively. Based on a threshold of AHI ≥5 events/h, HSAT had 94.6% sensitivity, 75% specificity, compared to PSG. For detecting Cheyne-Stokes respiration (CSR), a sensitivity of 96.4%,a specificity of 97.2% were achieved, compared to PSG.

Type 3 PM can be used to diagnose SDB in patients with CHF.

To analyze the cumulative reoperation rate of postoperative Crohn′s disease (CD) patients and investigate the operation reasons and the effects of drugs on surgical recurrence.

Patients with Crohn′s disease who had undergone intestinal resection from January 2000 to March 2020 in Peking Union Medical College Hospital were enrolled. Patients were divided into reoperation and non-reoperation group according to whether they had a second operation. And the basic characteristics and the reasons for the primary and second operation were retrospectively analyzed. Meanwhile, patients were divided into low-risk reoperation group and high-risk group based on risk stratification. Kaplan-Meier methods were performed to analyze the cumulative surgical recurrence rate and to compare the recurrence rate in different risk stratification and chi-square tests was used to analyze the effects of different maintenance drugs on reoperation.

A total of 160 patients were enrolled in the study. There were 110 males and 50 females, and the age at first operation was (35.6±14.1) years old. There were 40 patients in the reoperation group and 120 patients in the non-reoperation group. According to univariate analysis, the proportion of male gender(P=0.030), penetrating phenotype(P<0.001), history of appendectomy before the primary surgery(P=0.035) and no postoperative maintenance therapy (P<0.001) were higher in surgical recurrence group. In terms of the operation reasons, intestinal obstruction accounted for the highest proportion in the primary operation (26.9%, 43/160), while the intestinal fistula was the most common reason for reoperation (42.5%, 17/40). After the primary surgery, the cumulative reoperation rates at 1, 3, 5 and 10 years were 5.9% (9 cases), 12.3% (17 cases), 21.8% (25 cases) and 37.6% (34 cases), respectively. The ten years cumulative reoperation rate of the high-risk group was 42.8% (31 cases), which was much higher than that of low-risk group (19.8%, 3 cases), and the difference was statistically significant (P=0.006). There was no statistically significant difference in the surgical recurrence rate of low-risk group patients(P=0.076)whether maintenance therapies were added or not, while the recurrence rate of high-risk group patients who did not receive maintenance therapy was higher than those who received immunosuppressant with or without (±) 5-aminosalicylic acid (ASA) (P=0.001) and biological agent±5-ASA (P=0.001), and the difference was statistically significant.

Patients with CD are still at risk of reoperation after surgery. Immunosuppressive agents and biologics can prevent patients from reoperation in high-risk groups.

To evaluate the safety, short- and mid-term outcomes of percutaneous balloon mitral valvuloplasty (PBMV) guided by the ultrasound.

In this retrospective study, medical data of 15 patients [9 males and 6 females, with an age of (53±13) years] with PBMV under the guidance of ultrasound in Heart Center of Henan Provincial People′s Hospital between December 2016 and January 2019 were collected and reviewed. The short-and mid-term outcomes were analyzed.

PBMV was successfully performed in all the patients. One patient underwent surgical valve replacement due to severe mitral regurgitation, and the other 14 patients were all followed up successfully. The average follow-up time was (13.8±4.6) months. Comparisons of preoperative and postoperative data showed significant differences in valve area [(1.84±0.43) cm² vs (0.89±0.24) cm²], left atrial pressure [(11.9±4.5) mmHg (1 mmHg=0.133 kPa) vs (21.9±6.0) mmHg] and mean mitral valve pressure gradient [(10.9±3.2) mmHg vs (20.1±3.6) mmHg](allP<0.01), with no significant differences in mitral regurgitation area (P=0.67). Postoperative follow-up showed that there were no significant differences in mitral valve area, regurgitation area and N-terminal pro-B-type natriuretic peptide (NT-proBNP) between short-and mid-term postoperatively (all P>0.05). There was no secondary operation due to mitral stenosis in 14 patients, and 3 patients with moderate or severe tricuspid regurgitation showed significant improvement, with gradually recovered cardiac function, and there were no deaths in these patients.

PBMV guided by the ultrasound is feasible and effective, and exhibits favorable short-and mid-term outcomes.

To study the prevalence and genetic characteristics of human respiratory syncytial virus (HRSV) in Quanzhou city, from 2018 to 2019.

A total of 141 throat swabs were collected from children patients of lower respiratory tract infection in Quanzhou children Hospital, Fujian Province from November 2018 to May 2019. RT-PCR was used to amplify the 3 ′end of G gene HRSV. Sequencer 5.0 and MEGA5.05 softwares were used for sequence editing, phylogenetic tree construction and genotyping analysis.

Twenty-five samples were positive for HRSV. Seventeen samples succeeded to obtain the target gene, including 13 of HRSVA and 4 of HRSVB. Two genotypes were identified: ON1 genotype (13 samples, HRSVA) and BA9 genotype (4 samples, HRSVB). Five strains of ON1 genotype sequences were clustered with the ON1 sequences prevalent in Beijing, Changchun and Zhejiang from 2012 to 2015 (cluster1); one strain (FJ19-02) was clustered with the sequences of ON1 genotype circulating in many regions of China from 2012 to 2015 (cluster2); Seven strains were clustered independently (cluster FJ). FJ18-02, FJ19-14 and FJ19-15 of HRSVB were clustered with the BA9 genotype sequences prevalent in Changchun, Jilin Province in 2015, while FJ19-13 was closely related to the BA9 genotype sequences prevalent in Guangzhou and Zhejiang Province in 2013. Both the ON1 and BA9 genotypes showed variations of nucleotide and amino acid in 72 and 60 insertion segments. Amino acid mutation (H266L) only occurred among the sequence of cluster-FJ, and the mutations of H261Q and Q265L only appeared in strain FJ19-13.

BA9 and ON1 genotypes were prevalent in Quanzhou city, from 2018 to 2019. Cluster-FJ was a newly discovered independent transmission chain, which may continue to circulate in local Quanzhou area.

Erdheim-Chester disease (ECD) is a rare multi-system involved histiocytic infiltrative disease, and bone is most commonly involved. However, the clinical and conventional imaging manifestations are not specific, and the risk of bone biopsy is high and the trauma is large, which makes the diagnosis and treatment of this disease difficult. This article describes in detail the bone lesions and differential diagnosis of a middle-aged woman with paroxysmal bone pain-osteosclerosis of limbs. Patients with symmetric multiple long bone diaphysis osteosclerosis suggested by imaging should be highly vigilant against ECD, and bone biopsy should be completed in time to provide clinical diagnosis and treatment experience for this rare disease.

In the past, sleep physiological monitoring and disease diagnosis almost entirely relied on polysomnography (PSG) in sleep centers, but its complexity, accessibility and impact on subject comfort are the shackles of its further development and application. With the emergence of emerging technologies, wearable devices designed to monitor sleep in natural environments are gradually being used in clinical practice and research, and the verification of accuracy and reliability is also continuously being carried out. This paper briefly explains the method flow of wearable devices in clinical evaluation, and summarizes the progress of related research on signals, monitorable indexes and reliability of various wearable devices in clinical application of various sleep disorders.

With the rise and development of artificial intelligence (AI) technology, the application of AI in the medical and health field is receiving increasing attention. This paper takes machine learning, deep learning and transfer learning as representatives, and summarizes the related research work in the field of sleep medicine, covering sleep staging, sleep spindle wave, sleep apnea, rapid eye movement sleep behavior disorder, insomnia and narcolepsy, etc. At the same time, the development trend of AI in the future is analyzed and discussed, and the advantages of AI in big data analysis and intelligent decision-making are given full play, so that it can be further popularized and applied in the field of sleep medicine.

Rheumatoid arthritis (RA) is an autoimmune disease characterized by chronic synovitis, articular cartilage and bone destruction. Anti-citrullinated protein/polypeptide antibodies (ACPAs) are RA-specific autoantibodies. In recent years, it has been found that autoantibodies against peptidylarginine deiminase 4 (PAD4) can also be detected in the serum of RA patients. This antibody has high specificity and is helpful for the diagnosis of RA. Anti-PAD4 antibody is related to the clinical manifestation, treatment response and prognosis of RA, and is expected to become a biomarker for the prognosis of RA. This article reviews the role of anti-PAD4 antibodies in RA.

Sleep is an important physical function of human body, which is vital to human health. The impact of sleep duration and sleep quality on health outcomes has received considerable attention in recent years. To assess independent risk factors for sleep length, as well as poorer sleep characteristics associated with cardiovascular disease, cancer, and mortality, the researchers conducted a prospective cohort study with a median mean follow-up length of 8.57 years. A total of 407,500 UK adults aged (55.99 ± 8.10) years and 53.93% female were included in the study. Adjusted hazard ratios (HR) for the association of sleep duration and sleep quality with cardiovascular disease, cancer, and mortality were calculated by the Cox proportional hazards model. The results showed that the risk of all-cause death (HR =1.25, 95% CI: 1.16-1.34; HR =1.30, 95% CI: 1.22-1.38), cardiovascular disease death (HR =1.27, 95% CI: 1.09-1.49; HR =1.32, 95% CI: 1.16-1.50) and cardiovascular disease onset (HR =1.23, 95% CI: 1.16-1.31; HR =1.08, 95% CI: 1.02-1.15) were higher in the population with sleep duration ≤5 h and ≥9 h compared with those with sleep duration 7 h. In addition, the risk of cancer death (HR =1.19, 95% CI: 1.10 to 1.30) and cancer development (HR =1.08, 95% CI: 1.04 to 1.12) were higher in people who slept for ≥9 h. Moreover, the incidence of cardiovascular disease was significantly associated with snoring, insomnia, and narcolepsy, with increased risks of 7%, 26%, and 20%, respectively. It can be seen that both long and short sleep can increase the risk of a series of adverse health consequences. Therefore, it is recommended to sleep for 7 to 8 hours a day. In addition, people at high risk of cardiovascular disease should be more vigilant about snoring, insomnia and narcolepsy. The above findings can further support sleep medicine research, disseminate and promote sleep hygiene knowledge to more people, thereby reducing the mortality and morbidity of related diseases

Obstructive sleep apnea (OSA) is a recurrent interruption of airflow in patients during sleep, lasting at least 10 s. Intermittent hypoxia caused by apnea is associated with cerebral cortical micro-arousal and decreased blood oxygen saturation. Clinically, OSA patients can be manifested as snoring, loud and irregular snoring, often suffocating or waking up at night, sleep rhythm disorder, dry mouth in the morning, dizziness, daytime drowsiness, memory loss, cognitive function decline and behavioral abnormalities in severe cases. In the United States, approximately 25% of adults have OSA. OSA is the leading cause of excessive sleepiness in patients and is associated with decreased quality of life, reduced productivity at work, and increased risk of motor vehicle accidents. More and more studies have shown that OSA is closely related to the increased incidence and mortality of hypertension, type 2 diabetes, atrial fibrillation, heart failure, coronary heart disease, stroke. Most patients with OSA can be diagnosed by a portable home sleep apnea monitoring device (HSAT), and its monitoring sensitivity is about 80%. Effective treatments for OSA include weight loss, physical exercise, continuous positive airway pressure therapy (CPAP), oral appliances and surgical treatment, and hypoglossal nerve stimulation therapy for BMI<32 kg/m2 Patients are effective. At present, there is no effective drug treatment for OSA. CPAP treatment can reduce blood pressure in patients with OSA, especially in patients with refractory hypertension. However, clinical randomized controlled trials have shown that CPAP treatment does not significantly reduce the incidence and mortality of cardiovascular and cerebrovascular events in OSA patients. This review comprehensively searched OSA-related articles included in Pubmed and Cochrane from January 2010 to February 2020, focusing on randomized controlled trials, systematic reviews, meta-analyses and clinical practice guidelines, and comprehensively elaborated the latest research progress in epidemiology, pathophysiology, diagnostics and treatment measures of OSA.

Narcolepsy is a sleep disorder characterized by the loss of hypocretin-1 neurons in the lateral hypothalamus and is associated with metabolic disorders. Despite extensive studies of metabolic alterations in patients with narcolepsy, the results remain controversial. To determine the metabolic profile of patients with narcolepsy, the researchers searched the main clinical databases PubMed and Scopus for literature related to narcolepsy metabolism until November 2, 2020, and conducted a systematic review and meta-analysis of the included literature. The quality of included studies was assessed using the Newcastle-Ottawa Scale (NOS) Literature Quality Evaluation Scale, combined effect sizes by fixed-effects models or random-effects models, heterogeneity of studies was measured by I2 index and Q-test, and publication bias was measured by funnel plots. Subgroup analysis and meta-regression analysis of potential moderators were performed to measure the effect of confounders on effect size. A total of 48 articles were included, and the age of the included population was 11.66 to 71.86 years old. The results showed that compared with the control group, the prevalence of obesity in narcolepsy patients (log OR =0.93, 95% CI: 0.73-1.13, P<0.001), diabetes prevalence (log OR =0.64, 95% CI: 0.34-0.94, P<0.001), prevalence of hypertension (log OR =0.33, 95% CI: 0.11-0.55, P<0.001) and the incidence of dyslipidemia (log OR =1.19, 95% CI: 0.60-1.77, P<0.001) is higher. In addition, narcolepsy had higher BMI (SMD =0.50, 95% CI: 0.32-0.68, P<0.001), thicker waist circumference (SMD =8.61, 95% CI: 2.03 to 15.19, P =0.01), and higher plasma insulin levels (SMD =0.61, 95% CI: 0.14 to 1.09, P =0.01). However, fasting blood glucose, basal metabolic rate-resting metabolic rate (BMR-RMR), systolic blood pressure, diastolic blood pressure, cerebrospinal fluid melanin concentrate hormone, serum growth hormone, plasma, and cerebrospinal fluid leptin were not significantly different in patients with narcolepsy compared with controls. Therefore, early screening of narcolepsy patients for metabolic alterations and cardiovascular risk factors is necessary, so as to reduce the morbidity and mortality of metabolic and cardiovascular diseases.

Crohn's disease (CD) is a chronic intestinal injury disease. In recent years, under the premise of widespread use of immunosuppressants and biologics, half of patients still have to be operated within 10 years after diagnosis. However, surgery cannot cure CD, and how to prevent postoperative recurrence is still a hot topic at present. Ustenumab is a humanized IgG1 κ monoclonal antibody that is a p40 protein subunit antagonist of interleukin (IL) -12 and IL-23. Previous studies have shown that ustenumab is more effective than placebo in inducing and maintaining clinical or endoscopic remission in patients with moderate to severe CD; However, it has not been clearly suggested that it can effectively prevent postoperative recurrence of CD. To compare the effectiveness of ustenumab and azathioprine in preventing endoscopic recurrence after CD surgery, the study included nine inflammatory bowel disease (IBD) centers and retrospectively analyzed 32 patients treated with ustenumab and 31 patients treated with azathioprine after CD surgery. Endoscopic recurrence was defined as a Rutgeerts score ≥ i2 at 6 months postoperatively. The results of this study showed that the endoscopic recurrence rate in the ustenumab-treated group at 6 months postoperatively was lower than that in the azathioprine-treated group (28.0% vs. 54.5%, P =0.029), that is, ustenumab is more effective than azathioprine in preventing endoscopic recurrence after CD surgery.